How structural and individual factors help explain socioeconomic inequalities in health behaviors

Abstract

Abstract Socioeconomic inequalities in health behaviors have been attributed to both structural and individual factors, but untangling the complex pathways through which these factors influence inequalities requires more research. We examined whether and how two factors, material conditions and time orientation, sequentially impact socioeconomic inequalities in health behaviors. Dutch adults 25 and older self-reported socioeconomic position (SEP) (educational level); material conditions (financial strain, housing tenure, income); time orientation; health behaviors including smoking and sports participation; and health behavior-related outcomes including body mass index (BMI) and self-assessed health in three waves (2004, 2011, 2014) of the longitudinal GLOBE study. Two hypothesized pathways were investigated during a ten-year time period using sequential mediation analysis, an approach that enabled correct temporal ordering and control for confounders like baseline health behavior. Educational level was negatively associated with BMI, positively associated with sports participation and self-assessed health, and not associated with smoking in the mediation models. For smoking, sports participation, and self-assessed health, a pathway from educational level to the outcome mediated by time orientation followed by material conditions was observed. Time orientation followed by material conditions may help explain socioeconomic inequalities in certain health behaviors, providing empirical support for the interplay between structural and individual factors. Smoking may be determined by prior smoking behavior regardless of SEP, potentially due to its addictive nature. While intervening on time orientation in adulthood may be challenging, the results from this study suggest that policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation. Key messages Socioeconomic inequalities in certain health behaviors were mediated by time orientation followed by material conditions, showing the importance of considering both structural and individual factors. Policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation.